Provider Demographics
NPI:1841295490
Name:ZITA, DAVID F (PHD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:F
Last Name:ZITA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:164 FOUR MILE RIVER RD
Mailing Address - Street 2:
Mailing Address - City:OLD LYME
Mailing Address - State:CT
Mailing Address - Zip Code:06371-1325
Mailing Address - Country:US
Mailing Address - Phone:860-434-8284
Mailing Address - Fax:
Practice Address - Street 1:164 FOUR MILE RIVER RD
Practice Address - Street 2:
Practice Address - City:OLD LYME
Practice Address - State:CT
Practice Address - Zip Code:06371-1325
Practice Address - Country:US
Practice Address - Phone:860-434-8284
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1085103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTR39271Medicare UPIN